Objective:

To systematically evaluate the efficacy and safety of linaclotide combined with polyethylene glycol (PEG) compared to PEG alone for bowel preparation in constipated patients.

Approach:

• Search Strategy: A systematic search was conducted in multiple databases to identify randomized controlled trials (RCTs) comparing linaclotide-PEG with PEG monotherapy in constipated patients.
• Inclusion Criteria: Adult patients with chronic constipation, RCTs evaluating linaclotide-PEG, clearly reported outcome measures, and comparable baseline characteristics.
• Exclusion Criteria: Reviews, case reports, and studies not meeting the inclusion criteria were excluded.

Key Findings:

• Linaclotide-PEG significantly improved overall bowel preparation quality (MD=0.82; 95% CI: 0.58-1.05; P < 0.05).
• Segment-specific cleansing scores also improved for left colon (MD=0.28; P < 0.05), right colon (MD=0.34; P < 0.05), and transverse colon (MD=0.35; P < 0.05).
• Increased polyp detection rates and improved procedural duration and cecal intubation times were observed (all P < 0.05).
• Patients' willingness to repeat colonoscopy improved significantly (P < 0.05).
• Linaclotide-PEG reduced adverse reactions, including nausea and vomiting (P < 0.05).

Interpretation:

Linaclotide-PEG is superior to PEG alone in enhancing bowel cleansing effectiveness and reducing adverse events.

Limitations:

• The study quality was assessed using the Cochrane Risk of Bias (RoB 2) tool, which may introduce subjectivity.
• The search was limited to specific databases and may not encompass all relevant studies.

Conclusion:

Linaclotide-PEG demonstrates advantages over PEG alone for bowel preparation in constipated patients.

Sources:

• Systematic Review Registration